Method and device for suture manipulation

ABSTRACT

The invention relates to a suture manipulation device. The suture manipulation device includes a body and a snare. The snare is operatively connected to the body and is adapted to protract from the body, and after protracting from the body, rotate independent of the body. The snare is further adapted to ensnare a portion of suture passed through tissue while rotating, and secure the portion of the suture.

BACKGROUND

In surgical applications, suture is passed through tissue to closewounds or surgical incisions. The suture holds one or more tissuestogether for a period of time. Because of constrained and sometimesinflexible spaces in which to work, surgeons and other medical personnelmust use specialized tools to apply suture to a wound. Specifically,suture manipulation such as puncturing tissue to release suture and/orretrieving suture to complete a stitch requires specialized tools.

SUMMARY

In general, in one aspect, the invention relates to a suturemanipulation device. The suture manipulation device includes a body anda snare. The snare is operatively connected to the body and is adaptedto (1) protract from the body, (2) rotate, after protracting from thebody, independent of the body, (3) ensnare a portion of suture passedthrough tissue while rotating, and (4) secure the portion of the suture.

In general, in one aspect, the invention relates to a suturemanipulation device. The suture manipulation device includes a snarewith a receiving end that is adapted to (1) provide support to tissue,(2) ensnare a portion of suture passed through the tissue and thereceiving end, (3) remove the support of the tissue, (4) secure, whileremoving the support of the tissue, the portion of the suture using thereceiving end, and (5) remove, using the receiving end, the portion ofthe suture.

In general, in one aspect, the invention relates to a method formanipulating a suture. The method involves (1) protracting a snare froma body of a suture manipulation device, (2) rotating the snareindependent of the body of the suture manipulation device, (3) ensnaringa portion of the suture with the snare while rotating the snare, and (4)securing the portion of the suture.

In general, in one aspect, the invention relates to a method formanipulating a suture. The method involves (1) providing support totissue using a snare of a suture manipulation device, (2) ensnaring,using the snare and without moving the snare, a portion of the suturewhen the portion of the suture passes through the tissue and is releasedby a needle, (3) securing, while removing the support to the tissue, theportion of the suture with the snare, and (4) removing the snare withthe portion of the suture from the tissue.

Other aspects of the invention will be apparent from the followingdescription and the appended claims.

BRIEF DESCRIPTION OF DRAWINGS

FIGS. 1A and 1B show a suturing tool, known in the art, adapted toremove a suture.

FIGS. 2A and 2B each show a flowchart of a method in accordance with oneor more embodiments of the invention.

FIGS. 3A through 3D show a suturing tool with suture retrievalcapability in accordance with one or more embodiments of the invention.

FIGS. 4A through 4D show rotating a snare in accordance with one or moreembodiments of the invention.

FIG. 5 shows retracting the snare in accordance with one or moreembodiments of the invention.

FIGS. 6A through 6D show rotating a snare in accordance with one or moreembodiments of the invention.

FIGS. 7A through 7D show retracting the snare in accordance with one ormore embodiments of the invention.

FIG. 8 shows an example of a suturing tool with suture retrievalcapability in accordance with one or more embodiments of the invention.

FIGS. 9A through 10B show an example of retrieving a suture inaccordance with one or more embodiments of the invention.

FIGS. 11A through 11H show an example of retrieving a suture inaccordance with one or more embodiments of the invention.

FIGS. 12A through 12D show an example of retrieving a suture inaccordance with one or more embodiments of the invention.

DETAILED DESCRIPTION

Specific embodiments of the invention will now be described in detailwith reference to the accompanying figures. Like elements in the variousfigures are denoted by like reference numerals for consistency.

In the following detailed description of embodiments of the invention,numerous specific details are set forth in order to provide a morethorough understanding of the invention. However, it will be apparent toone of ordinary skill in the art that the invention may be practicedwithout these specific details. In other instances, well-known featureshave not been described in detail to avoid unnecessarily complicatingthe description.

In general, embodiments of the invention describe a method and devicefor suture manipulation. Specifically, one or more embodiments of theinvention protract a snare from a body of a suture manipulation device.Once protracted, the snare rotates independent of the body of the suturemanipulation device to ensnare a portion of the suture. The snare thensecures the portion of the suture. In one or more embodiments of theinvention, a pushrod, located in a cavity of the body of the suturemanipulation device, is used to control the snare. When a pushrod isretracted, the snare may also be retracted. A pushrod may also rotateindependent of the body of the suture manipulation device. For example,the suture manipulation device itself may not rotate when the snaredoes, whether controlled by the pushrod, for example in the ensnarementof a suture. As used herein, suture may refer to suture thread.

In one or more embodiments of the invention, manipulation of a suturemay involve pushing a suture through tissue, moving a suture, dropping asuture (i.e., releasing the suture, at least in part, from a needle),retrieving a suture, extracting a suture, and/or otherwise moving asuture. As used herein, the suture manipulation device may be a suturepusher, a suture shuttle, a suture retriever, and/or any other suitabledevice for manipulating a suture. In other words, the suturemanipulation device may be configured to manipulate a suture and/or ashuttle. As used herein, a suture may be permanent (i.e., used to createa stitch) or temporary (e.g., a shuttle that is pushed through tissue,where an end of the shuttle is tied to a permanent suture used to createa stitch).

Embodiments of the invention are designed to support the creation of oneor more stitches. A stitch uses a suture to hold one or more materialsin place over a period of time. A stitch is created when a suture isinserted into and pushed through (i.e., passed through) tissue. Tissuemay include, but is not limited to, epithelial and other layeredcovering tissue (e.g., the outer layer of skin, and tissue surroundinginternal organs such as the liver), connective tissue (e.g., inner layerof skin, tendons, ligaments, cartilage, bone, fat), muscle tissue, andnerve tissue. A suture may be any suture used in surgical and othersimilar procedures. For example, a suture may range in size from #11/0United States Pharmacopeia (USP) to #7 USP. Further, a suture may bemade from a number of materials, including but not limited to silk,catgut, polyglycolic acid, polyactic acid, polydioxanone, nylon, andpolypropylene. Embodiments of the invention may be used to manipulate(e.g., push, ensnare, secure, extract) suture inside a body (e.g.,human, animal) and/or external to the body (as with a surface wound).

As used herein, the term distal means the most distant point. Also, theterm proximal means the closest point. The perspective from which distaland proximal are described herein is an operator of a tool having one ormore components. Specifically, embodiments of the invention describe adevice (e.g., a suture retriever, a suture shuttle) used in surgicalapplications to stitch a wound or other opening of tissue. The distalend describes the end of the device (or component of the device) closestto the tissue (i.e., furthest away from a user of the device). Likewise,the proximal end describes the end of the device (or component of thedevice) closest to the user of the device (i.e., furthest away from thetissue). Also, as used herein, a user may be any person creatingstitches in tissue, including but not limited to a surgeon, a nurse, atechnician, or a veterinarian.

FIGS. 1A and 1B show a suture manipulation device (e.g., a sutureretriever) known in the art. As shown in FIG. 1A, the suturemanipulation tool includes a shaft (102), a pointed end (104), and aclamping arm (106) that yields a gap (108) between a portion of theshaft (102) and the underside of the clamping arm (106). The end of theclamping arm (106) may be joined against a notch (110) in the shaft(102) when the clamping arm (106) is in a closed position. The clampingarm (106) shown in FIG. 1A is in a closed position, which may be usedwhen inserting the suture manipulation device into an area to manipulatea suture. The material with which the shaft (102), the pointed end (104)(e.g., a needle), and the clamping arm (106) are made from may be thesame or one or more different materials. The suture manipulation devicemay be made for repeated use, or for temporary (e.g., one time) use.

FIG. 1B shows the suture manipulation device of FIG. 1A where theclamping arm (126) is in an open position. Specifically, the clampingarm (126) is in an open position to secure a suture. The clamping arm(126) may be opened in one of a number of ways, including release of alatch, applying pressure on a hinge, or some other suitable mechanism.The mechanism used to open the clamping arm may be located at one ormore locations, including but not limited to the hinge of the clampingarm (126) to the body (122) and the notch (130). When the clamping arm(126) is open, the gap (128), combined with the notch (130), may be usedto capture the suture.

A suture manipulation device, as described above with respect to FIGS.1A and 1B, may be configured to manipulate (e.g., pass, drop, retrieve)a suture and/or a suture shuttle. An example of suture manipulationdevices known in the art includes, but is not limited to, the ACCU-PASS®suture shuttles. (ACCU-PASS® is a registered trademark of Smith &Nephew, Inc. of Memphis, Tenn.)

FIGS. 2A and 2B each show a flowchart of a method for manipulating asuture in accordance with one or more embodiments of the invention.While the various steps in these flowcharts are presented and describedsequentially, some or all of the steps may be executed in differentorders, may be combined or omitted, and some or all of the steps may beexecuted in parallel. Further, in one or more of the embodiments of theinvention, one or more of the steps described below may be omitted,repeated, and/or performed in a different order. In addition, additionalsteps, omitted in FIGS. 2A and 2B, may be included in performing thesemethods. Accordingly, the specific arrangement of steps shown in FIGS.2A and 2B should not be construed as limiting the scope of theinvention.

Referring to FIG. 2A, one method for manipulating a suture in accordancewith one or more embodiments of the invention is described. In Step 202,a suture is passed through tissue using a needle. The needle may be partof a suture manipulation device without suture retrieving capability ora suture manipulation device with suture retrieving capability. A suturemanipulation device may be any device capable of puncturing (i.e.,piercing) the tissue and securing the suture as the suture manipulationdevice, along with the suture, is pushed beyond the tissue. The suturemanipulation device may include a penetrating component (i.e., needle)at the distal end. The needle of the suture manipulation device may bestraight or curved. A cross section of the needle may be circular, oval,or any other suitable shape. The needle may have a diameter (or lengthof a major axis) that may be as small as 1 mm (or less) or as large as2.5 mm (or larger). The size of the needle may depend on the size (e.g.,diameter) of the suture. The needle may be several inches long and havea proximal end that attaches to a body that may include a handle.

In Step 204, the suture is released by the needle. In one or moreembodiments of the invention, the suture may be released from the needleusing natural forces. For example, if the needle is extended a distance(e.g., one inch) beyond the tissue and snare, friction created byelements within the body receiving the suture may be adequate to releasethe suture from the needle as the needle retracts. The suture may alsobe released from the suture manipulation device using some control. Thecontrol may be manual (e.g., a user pressing a button) or automatic(e.g., the suture is released after the suture manipulation devicetravels five millimeters past the tissue). Also, the control may belocated on the suture manipulation device (e.g., on the handle of thesuture manipulation device) or remote from the suture manipulationdevice (e.g., remote control). As an example, the suture manipulationdevice may include a snare (e.g., a hook) that holds the suture in aretracted position when the suture manipulation device penetrates andtraverses through the tissue. The snare may then extend and/or rotate todrop (i.e., release) the suture from the suture manipulation device. Thesnare may release all or a portion of the suture.

Optionally, in Step 205, if the suture manipulation device is adifferent tool from the suture device, then the suture manipulationdevice is removed from the tissue after the suture is released from theneedle. Optional Step 205 may also be performed if the suture passesback through different tissue or the same tissue but in an areaproximate to the point in the tissue where the suture manipulationdevice passed. Further, in Step 206, a suture manipulation device isinserted in the tissue. In one or more embodiments of the invention, thesuture manipulation device used to pass the suture is different from thesuture manipulation device used to retrieve the suture. The suturemanipulation device may be inserted in the same tissue, at a locationproximate to where the suture was inserted using the suture manipulationdevice in Step 202. Alternatively, the suture manipulation device may beinserted in different (e.g., adjacent) tissue than the tissue throughwhich the suture is passed by the suture manipulation device.

In Step 208, the snare of the suture manipulation device is extended.This Step 208 is performed if the snare is not already extended. Thesnare may be extended from the suture manipulation device using somecontrol. The control may be manual (e.g., a user pressing a button) orautomatic (e.g., the snare is released after the suture manipulationdevice travels ten millimeters past the tissue). Also, the control maybe located on the suture manipulation device (e.g., on the handle of thesuture manipulation device) or remote from the suture manipulationdevice (e.g., remote control).

Optionally, in Step 210, the snare is rotated. In one or moreembodiments of the invention, the snare is rotated to ensnare thesuture. The snare may be rotated by the base of the snare, so that thesuture manipulation device itself does not rotate. The snare may also berotated axially by turning the snare along the longitudinal and/orradial axis of the snare. The snare may also be rotated by a combinationof rotations described herein and/or by other rotations known in theart. The snare may rotate in one or more full revolutions or a partialrevolution. The snare may rotate clockwise or counterclockwise. Thesnare may be rotated from the suture manipulation device using somecontrol. The control may be manual (e.g., a user pressing a button) orautomatic (e.g., the snare is rotated one second after the snare isextended from the suture manipulation device). Also, the control may belocated on the suture manipulation device (e.g., on the handle of thesuture manipulation device) or remote from the suture manipulationdevice (e.g., remote control).

In Step 212, the suture is ensnared by the snare. If the snare isrotated, then the snare may be ensnared during the rotation of thesnare. The suture may also be ensnared in one of a number of other ways.For example, a user may position the suture within the snare so that thesuture becomes ensnared by the snare. As another example, the suturemanipulation device (or some portion thereof) may be moved in somesuitable manner as to ensnare the suture in the snare.

Optionally, in Step 214, the snare is retracted toward the suturemanipulation device. Retraction of the snare toward the suturemanipulation device may be partial (e.g., thirteen millimeters withfurther retraction possible) or full (i.e., the snare may not beretracted further). The snare may be retracted toward the suturemanipulation device using some control. The control may be manual (e.g.,a user pressing a button) or automatic (e.g., the snare is retractedafter the snare has rotated for one full revolution). Also, the controlmay be located on the suture manipulation device (e.g., on the handle ofthe suture manipulation device) or remote from the suture manipulationdevice (e.g., remote control). In one or more embodiments of theinvention, the suture is secured by the snare without retracting thesnare toward the suture manipulation device.

In Step 216, a determination is made as to whether the suture issecured. Determining that the suture is secured may be performedmanually (e.g., in sight of the user, using a viewing device (e.g., anendoscope during arthroscopic surgery)) or automatically. Thedetermination that the suture is secured may occur automatically usingone or more sensors and/or other devices adapted to make such adetermination. For example, a sensor may be adapted to measure theamount of force (e.g., tension) required to retract the snare. In such acase, if the force used to retract the snare is below a threshold force,then the sensor indicates to the user that the suture is not secure andthat the snare needs to be extracted and rotated again to secure thesuture. Alternatively, when the force used to retract the snare is abovea threshold force, the sensor may automatically extract and/or rotatethe snare again to secure the suture. If the suture has not beensecured, then the process reverts to Step 208. If the suture has beensecured, then the process proceeds to Step 218.

In Step 218, the suture manipulation device with the suture is retractedfrom the tissue. The suture manipulation device may be retractedmanually (as by the user) or automatically (as when using an automatedprocess). When Step 218 is complete, the process ends.

Referring to FIG. 2B, another method for manipulating a suture inaccordance with one or more embodiments of the invention is described.In Step 252, tissue is secured using a snare of a suture manipulationdevice. The tissue may be secured by the snare in one of a number ofways. For example, the snare may provide support for the tissue byclamping on the tissue, by providing a brace against which the tissuemay rest, by providing a support to the tissue, by using some othersuitable means of securing the tissue, or by using any combinationthereof In one or more embodiments of the invention, the tissue is softtissue that may move when being pierced.

In Step 254, a needle is protracted to pierce the tissue. In one or moreembodiments of the invention, the needle is integrated with the samesuture manipulation device as the device described above with respect toStep 252. The needle may move independently of the suture manipulationdevice. The distal end of the needle may include a distal end adapted tosecure and/or release the suture. The needle may be protracted usingsome control. The control may be manual (e.g., pushing on a plunger onthe handle of the suture manipulation device) or automatic (e.g., theneedle is protracted three seconds after the snare secures the tissue).Also, the control may be located on the suture manipulation device(e.g., on the handle of the suture manipulation device) or remote fromthe suture manipulation device (e.g., remote control).

In Step 256, the suture is passed through the tissue and the snare usingthe needle. The distance that the suture (i.e., the distal end of theneedle) passes beyond the tissue and the snare securing the tissue mayvary. Further, in one or more embodiments of the invention, the suturemanipulation device may be configured in such a way that the needlepasses substantially close to the snare after exiting the tissue.

In Step 258, the suture is released from the needle. The suture may bereleased from the needle using natural forces. For example, if theneedle is extended a distance (e.g., one inch) beyond the tissue andsnare, friction created by elements within the body receiving the suturemay be adequate to release the suture from the needle as the needleretracts. The suture may also be released from the needle using somecontrol (e.g., release of a jam cleat). The needle may release all or aportion of the suture. The control, if any, used to release the suturefrom the needle may be manual (e.g., a user pressing a button) orautomatic (e.g., the suture is released after the needle travels fivemillimeters past the tissue). Also, the control may be located on thesuture manipulation device (e.g., on the handle of the suturemanipulation device) or remote from the suture manipulation device(e.g., remote control).

In Step 260, the needle is retracted from the tissue. In one or moreembodiments of the invention, the needle is retracted while the snare ofthe suture manipulation device remains substantially in place providingsupport to the tissue. The needle may be retracted from the tissue usingsome control. The control may be manual (e.g., a pulling on a plunger onthe handle of the suture manipulation device) or automatic (e.g., theneedle is retracted after the needle has been passed through the tissuefor three seconds). Also, the control may be located on the suturemanipulation device (e.g., on the handle of the suture manipulationdevice) or remote from the suture manipulation device (e.g., remotecontrol).

In Step 262, the suture is ensnared with the snare. In one or moreembodiments of the invention, the snare ensnares the suture as theneedle is retracted. The snare may also ensnare the suture by moving thesnare so that the snare is properly oriented to ensnare the suture. Forexample, the snare may be moved upward toward the suture to ensnare thesuture.

In Step 264, a determination is made as to whether the suture issecured. Determining that the suture is secured may be performedmanually (e.g., in sight of the user, using a viewing device (e.g., anendoscope during arthroscopic surgery)) or automatically. If the suturehas not been secured, then the process proceeds to Step 266. If thesuture has been secured, then the process proceeds to Step 268.

In Step 266, the snare is maneuvered. In one or more embodiments of theinvention, the snare is maneuvered to secure the suture in the snare.After the snare is maneuvered, the process reverts to Step 264 todetermine whether the maneuvering of the snare secured the suture.

In Step 268, after the suture is secured by the snare, the snare isremoved with the suture. The snare may be removed in one of a number ofways. For example, the entire suture manipulation device, to which thesnare is fixedly attached, may be removed. As another example, the snare(along with the rest of the suture manipulation device) may be retractedusing some control. The control may be manual (e.g., pushing a button onthe handle of the suture manipulation device) or automatic (e.g., thesnare is protracted one second after the suture is secured). Also, thecontrol may be located on the suture manipulation device (e.g., on thehandle of the suture manipulation device) or remote from the suturemanipulation device (e.g., remote control). After the snare is removedwith the suture, the process ends.

FIGS. 3A through 3D show a suture manipulation device with sutureretrieval capability in accordance with one or more embodiments of theinvention. FIG. 3A shows a cross-section of a suture manipulation devicewith suture retrieval capability that includes a body (302) having acavity (314) adapted to accommodate a pushrod (304), and a needle (306)with a channel (308) adapted to allow a suture (310) to pass through. Asnare (312) is attached at the distal end of the pushrod (304). Each ofthese components is described below. Embodiments of the invention arenot limited to the configuration shown in FIGS. 3A and 3B and discussedherein.

In one or more embodiments of the invention, the suture (310) is held inplace in the channel (308) of the needle (306) by the pushrod (304) whenthe pushrod (304) is moved toward the distal end and contacts the suture(310). The suture (310) may also be held in place in the channel (308)of the needle (306) using one or more other means that do not includeuse of the pushrod (304). For example, the suture (310) may be held inplace by friction, as when the channel (308) is sized slightly largerthan the size of the suture (310) or when extra suture (310) is threadedthrough the needle (306) such that, as the needle (306) is passedthrough tissue, both ends of the suture (310) trail the needle (306) andpass along toward the proximate end of the suture manipulation device.As another example, the suture manipulation device may include aretractable notch (e.g., a jam cleat), embedded into the body (302) atthe distal end, that extends into the channel (308) to hold the suture(310) in place in the channel (308). The suture (310) may be held inplace prior to and while the suture manipulation device is inserted intoand passed through tissue to begin a stitch. Aside from the channel(308) in the needle (306), the suture (310) may be external to thesuture manipulation device in embodiments of the invention.

In one or more embodiments of the invention, the needle (306) is used topenetrate tissue. The needle may be of any length and/or shape and maybe made of any material designed to penetrate tissue and similarmaterial so that the suture (310) may be inserted through such material.Examples of a shape of the needle (306) include, but are not limited to,straight, ¼ circle, ⅜ circle, ½ circle, ⅝ circle, compound curve, halfcurved (also known as ski), and half curved at both ends of a straightsegment (also known as canoe). The needle (306) may also be classified,based on its point geometry. Examples of classifications of the needle(306) include, but are not limited to, taper, cutting, reverse cutting,taper cut, blunt point, and spatula point. Further, in one or moreembodiments of the invention, the diameter of the needle (306) (as wellas at least the portion of the body (302) that penetrates the tissue andother such material) is approximately the same as, or slightly greaterthan, the diameter of the suture (310).

In one or more embodiments of the invention, the pushrod (304) may bemoved toward the distal end and/or the proximal end of the suturemanipulation device manually (e.g., by pushing and/or pulling on aportion of the pushrod (304) extending beyond the proximal end of thebody (302)), using a motorized control, using a pneumatic control, orusing some other mechanism. A control used to control the position ofthe pushrod (304) inside the cavity (314) of the body (302) may belocated at the proximal end of the body (302) (as on a handle), using aremote control device, or using some other suitable means of control. Inone or more embodiments of the invention, the pushrod (304), as well asthe cavity (314) of the body (302) into which the pushrod (304) resides,are circular in shape. In such a case, the pushrod (304) may be movedwithin the cavity (314) of the body (302) laterally and/or rotationally.The cavity (314) may be shaped in such a way as to allow the pushrod(304) to move within the cavity (314) in order to hold the suture (310)in place and/or to maneuver the snare (312) to capture the suture (310).

In one or more embodiments of the invention, when the pushrod (304) ispositioned toward the distal end of the body (302) of the suturemanipulation device, the snare (312) is threaded through the channel(308) in the needle (306) so that the remainder of the snare (312)(i.e., the portion of the snare (312) used to ensnare the suture) islocated outside of the suture manipulation device. The base of the snare(312) may be attached to the end of the pushrod (304) at the distal end.In such a case, the base of the snare (312) may be attached to anyportion of the end of the pushrod (304), including a portion that isoffset from the center of the end of the pushrod (304). The snare (312)may be in one of a number of shapes, including but not limited to aclosed loop and a hook.

The snare (312) may be made of one or more of a number of differentmaterials having one or more different properties. For example, thesnare (312) may be made of nitinol, a flexible metal, plastic, and/orsome other suitable material. The snare (312) may have uniform orvarying thicknesses throughout the length of the snare (312). Further,different portions of the snare (312) may be made of different material.For example, the base of the snare (312) attached to the end of thepushrod (304) may be made of nylon, while the rest of the snare (312)may be made of a flexible metal. The snare (312) may be of anappropriate size such that the snare (312) and the suture (310) may fitwithin the channel (308) at the same time.

In one or more embodiments of the invention, the body (302), the pushrod(304), and the needle (306) may be made of one or more of a number ofdifferent materials having one or more different properties. Forexample, the body (312) may be made of stainless steel, the pushrod(304) may be made of plastic, and the needle (306) may be made oftitanium. The body (302) may have varying contours and/or features alongits length. For example, toward the proximal end of the body (302), ahandle may be contoured and/or made or coated with a material (e.g.,rubber) to facilitate easier gripping and control by a hand using thesuturing tool with suture retrieval capability. The body (302) may alsoinclude one or more control devices (e.g., button, knob) to performfunctions to manipulate a suture.

FIG. 3B shows a variation of using the suture manipulation device withsuture retrieval capability as described above with respect to FIG. 3A.Specifically, when the suture manipulation device with suture retrievalcapability is inserted into tissue, the suture (330) may be heldsecurely by retracting, rather than fully inserting, the pushrod (324)within the cavity (334) of the body (322). In other words, rather thanuse the force of the pushrod (324) against the suture (330) in thechannel (328) to hold the suture (330) in place, as described above withrespect to FIG. 3A, the suture (330) may be held in place by retractingthe pushrod (324) within the cavity (334) to the extent that the snare(332), attached to the end of the pushrod (324), is fully extended.Consequently, the force of the snare (332) pulling on the suture (330)toward the cavity (334) (i.e., toward the proximal end) may hold thesuture (330) in place within the channel (328) of the needle (326). Whenthe suture (330) is ready to be released for retrieval and completion ofa stitch, the pushrod (324) is advanced toward the distal end so thatthe snare (332) slackens and no longer applies a force to the suture(330). The suture (330) may be dislodged from the channel (328) in oneof a number of ways. For example, the suture manipulation device may beadvanced while the suture (330) is held stationary. As a consequence,the suture (330) may slip away from the channel (328).

FIG. 3C shows a view of the suture manipulation device with sutureretrieval capability of FIGS. 3A and 3B in accordance with one or moreembodiments of the invention. In this case, the suture (not shown) hasbeen released from the channel (348) in the body (342) of the needle.Here, the snare (352) is positioned, using the pushrod (344), to ensnarethe suture for retrieval. FIGS. 4A through 4D, described below, show howthe snare may be used to ensnare the suture for retrieval in accordancewith one or more embodiments of the invention.

FIG. 3D shows one or more embodiments of the invention where the suturemanipulation device (372) has a hollow needle, distally located, with ablunted end (376). The blunted end (376) of the suture manipulationdevice (372) may be slotted (e.g., a flattened tubular shape, as shownin FIG. 3D), or have some other shape with a sharp tissue-penetratingdistal tip. The snare (374) in this FIG. 3D protrudes from the bluntedend (376) rather than from a side-facing opening of the needle, asdescribed for FIGS. 3A-3C above. The snare (374) may be extended fromthe blunted end (376) of the suture manipulation device (372) to ensnarethe suture (not shown). Once the suture is ensnared, the snare (374) maybe aligned (e.g., to fit in the opening at the blunted end (376)) andretracted into the suturing tool (374). The snare (374) may becontrolled (e.g., extracted, protracted, rotated) using a pushrod (notshown) or other control mechanism.

In FIGS. 4A through 4D, the pushrod (not shown), the end of which thesnare (e.g., 402, 412, 422, 432) is attached, is rotated so that thesnare (e.g., 402, 412, 422, 432) rotates around the body (e.g., 404,414, 424, 434) of the suture manipulation device with suture retrievalcapability. The snare (e.g., 404, 414, 424, 434) may be rotated by thebase of the snare (e.g., 404, 414, 424, 434), as shown in FIGS. 4Athrough 4D. The snare (e.g., 404, 414, 424, 434) may also be rotated inone or more other types of rotations, as described above with respect toFIG. 2A. The size of the snare (e.g., 402, 412, 422, 432) may be reducedby retracting the pushrod toward the proximal end of the suturemanipulation device. Conversely, the size of the snare (e.g., 402, 412,422, 432) may be increased by protracting the pushrod toward the distalend. Further, the angle at which the snare (e.g., 402, 412, 422, 432)creates relative to the suture manipulation device (in this example,approximately 30°) may be controlled to better ensnare the suture. Forexample, the entire suture manipulation device may be retracted awayfrom the tissue and suture to decrease the angle. Conversely, the entiresuture manipulation device may be protracted toward the tissue andsuture to increase the angle. The angle at which the snare (e.g., 402,412, 422, 432) creates relative to the suture manipulation device mayalso be controlled in a number of other ways, including but not limitedto using a lever, affixed to the end of the pushrod and the base of thesnare, that is adapted to push and/or pull a wire snare. The rotation ofthe snare (e.g., 402, 412, 422, 432) may end manually (e.g., flipping aswitch, ceasing a manual operation to rotate the snare) or after theoccurrence of some event (e.g., passage of time, ensnaring the suture).

FIG. 5 shows a suture (502) that has been ensnared and secured by thesnare (504) in accordance with one or more embodiments of the invention.In this case, the pushrod (506) is retracted toward the proximal end ofthe suture manipulation device to the point where the snare (504) istaught. The suture (502) is secured by the snare (504) against the body(508). Thus, when the pushrod (506) remains in the same position (i.e.,the snare is taught), the suture manipulation device may be extractedalong with the suture (502). The pushrod (506) may remain in place byuse of a locking mechanism (not shown). For example, the handle (notshown) of the suture manipulation device may include a button that locksthe pushrod (506) in place.

FIGS. 6A through 6D show a suture manipulation device with sutureretrieval capability in accordance with one or more embodiments of theinvention. In this case, the snare (e.g., 602, 612, 622, 632) is a hook.The hook may be made of thin wire, plastic, some other suitablematerial, or any combination thereof The shape and size of the snare(e.g., 602, 612, 622, 632) may vary. In this case, the shape of thesnare (e.g., 602, 612, 622, 632) includes a 180° arc at its distal endas well as a bend in the snare, just proximal to the 180° arc, where thelateral distance covered by the bend is equal to the diameter of the180° arc. In other words, the end of the 180° arc aligns with the baseof the snare before the bend. In one or more embodiments of theinvention, the diameter of the 180° arc is slightly larger than thediameter of the suture (not shown).

In one or more embodiments of the invention, the snare (e.g., 602, 612,622, 632) is protracted from and retracted into a slotted housing (e.g.,604, 614, 624, 634). As described above, the slotted housing (e.g., 604,614, 624, 634) may be sized and configured in such a way as to house thesnare (e.g., 602, 612, 622, 632) only when the snare is oriented in aspecific manner. In one or more embodiments of the invention, theslotted housing (e.g., 604, 614, 624, 634) protrudes from the body at ornear the distal end of the suture manipulation device. The pushrod maybe adapted, when fully protracted inside suture manipulation device, toextend the snare (e.g., 602, 612, 622, 632) through the slotted housing(e.g., 604, 614, 624, 634) of the body in order to manipulate the snare(e.g., 602, 612, 622, 632) to ensnare the suture.

As with the loop snare described above with respect to FIGS. 3A through5, the snare (e.g., 602, 612, 622, 632) of FIGS. 6A through 6D mayrotate independent of the movement of the suture manipulation device. Inthis case, the snare (e.g., 602, 612, 622, 632) rotates at a relativelyconstant angle relative to an axis emanating perpendicular to the suturemanipulation device from the base of the snare (e.g., 602, 612, 622,632). Such an angle may be changed by moving the snare (e.g., 602, 612,622, 632) distally or proximally within the slotted housing (e.g., 604,614, 624, 634). In one or more embodiments of the invention, the snare(e.g., 602, 612, 622, 632) has a natural state that is bent. In such acase, retracting the snare (e.g., 602, 612, 622, 632) may reduce anamount of the bend in the snare (e.g., 602, 612, 622, 632). The snare(e.g., 602, 612, 622, 632) may rotate based on a manual instruction(e.g., a user turning a knob on the handle of the suture manipulationdevice), a motorized instruction (e.g., turning a switch on a remotecontrol device), using some other suitable mechanism, or any combinationthereof The rotation of the snare (e.g., 602, 612, 622, 632) may endmanually (e.g., flipping a switch, ceasing a manual operation to rotatethe snare) or after the occurrence of some event (e.g., passage of time,ensnaring the suture).

As shown in FIGS. 7A through 7D, in one or more embodiments of theinvention, when the snare (e.g., 702, 712, 722, 732) is a hook or someother shape with a semi-flexible structure where the width and theheight differ, a slotted housing (e.g., 704, 714, 724, 734) with thesame (or slightly larger) width and height may be used. The slottedhousing (e.g., 704, 714, 724, 734) may serve to hide the snare (e.g.,702, 712, 722, 732) when the suture manipulation device is passing thesuture (not shown) through tissue (not shown). The slotted housing(e.g., 704, 714, 724, 734) may be configured to include a pointed tip(e.g., 706, 716, 726, 736) used to puncture the tissue and facilitatepassing the suture manipulation device through the tissue. As describedabove, the slotted housing (e.g., 704, 714, 724, 734), when not locatedat the tip of the needle, may not have a pointed tip (e.g., 706, 716,726, 736). In such a case, the slotted housing (e.g., 704, 714, 724,734) may be located on any outer surface of the suture manipulationdevice

As shown in FIG. 7A, the snare (e.g., 702, 712, 722, 732) may be fullyretracted into the slotted housing (e.g., 704, 714, 724, 734) when thesnare (e.g., 702, 712, 722, 732) is not securing the suture. By hidingthe snare (e.g., 702, 712, 722, 732) at the time the suture is passedthrough tissue, less trauma may be caused to the tissue because thesuture manipulation device has a relatively lower profile. In one ormore embodiments of the invention, after the suture manipulation devicepasses the suture (not shown) through the tissue (not shown), the snare(e.g., 702, 712, 722, 732) is protracted out of the slotted housing(e.g., 704, 714, 724, 734) as shown in FIG. 7B. As the snare (e.g., 702,712, 722, 732) is protracted, the snare (e.g., 702, 712, 722, 732) maybe rotated, as described above with respect to FIGS. 6A through 6D, tofacilitate capturing the suture.

Further, when the suture is ensnared by the snare (e.g., 702, 712, 722,732), the snare (e.g., 702, 712, 722, 732) may be retracted into theslotted housing (e.g., 704, 714, 724, 734) as shown in FIGS. 7C and 7D.Because of the dimensions of the slotted housing (e.g., 704, 714, 724,734), retracting the snare (e.g., 702, 712, 722, 732) into the slottedhousing (e.g., 704, 714, 724, 734) may only occur if the snare (e.g.,702, 712, 722, 732) is properly oriented with respect to the slottedhousing (e.g., 704, 714, 724, 734). Further, as shown in FIG. 7D, whenthe snare (e.g., 702, 712, 722, 732) is retracted into the slottedhousing (e.g., 704, 714, 724, 734), the snare (e.g., 702, 712, 722, 732)may protrude slightly beyond the slotted housing (e.g., 704, 714, 724,734). The snare (e.g., 702, 712, 722, 732) may protrude because thesuture (not shown), when secured by the snare (e.g., 702, 712, 722,732), may be wedged between the walls of the slotted housing (e.g., 704,714, 724, 734) and the snare (e.g., 702, 712, 722, 732), preventing hesnare (e.g., 702, 712, 722, 732) from fully retracting. In other words,the snare (e.g., 702, 712, 722, 732) may be substantially retracted, asshown in FIG. 7D, rather than fully retracted when the suture is securedby the snare (e.g., 702, 712, 722, 732).

FIG. 8 shows a suture manipulation device with suture retrievalcapability in accordance with one or more embodiments of the invention.The suture manipulation device of FIG. 8 includes a needle (802) thatmay be curved at the distal end (804), and a tip (806) with apenetrating point and means to hold and release suture (not shown) afterpassing the suture. In this case, the means to pass the suture is a slot(808) through the tip (806) that is large enough to allow the suture topass. The tip (806) may include a mechanism (e.g., rollers, aretractable and flexible pushrod in a channel inside the needle (802), amechanically-operated jam cleat inside the slot (808)) that allows auser to secure and/or release the suture.

The suture manipulation device may also include a suture retriever(810). In one or more embodiments of the invention, a snare (812)located at the distal end of the suture retriever (810) is adapted tosecure tissue in addition to retrieve a suture. The snare (812) of thesuture retriever (810) may secure tissue by clamping on the tissue,providing a brace against which the tissue may rest, providing a supportto the tissue, using some other suitable means of securing the tissue,or any combination thereof In one or more embodiments of the invention,the snare (812) of the suture retriever (810) may secure tissue so thatthe needle (802) may pierce the tissue without tissue migration awayfrom the penetration of the needle (802).

As shown in FIG. 8, the suture retriever (810) is two parallel rods, andthe snare (812) of the suture retriever (810) is a semi-circular loopconnecting the two rods and bent at some angle that is approximatelyperpendicular to the needle (802) as the needle (802) finishes passingthrough the tissue. In this case, the snare (812) is bent relative tothe two parallel rods of the suture retriever (810) so that the angleformed between the snare (812) and the needle (802), as the needle (802)bridges the snare (812), is approximately 110°, thus making passage intothe tissue easier. In general, embodiments of the invention may beconfigured so that the angle between the snare (812) and the needle(802) may vary. For example, the snare (812) and/or the needle (812) maybe adjusted to change the angle between the snare (812) and the needle(812). The angle between the snare (812) and the needle (812) may rangefrom slightly above 0° to 180°.

Under the configuration as shown in FIG. 8, the snare (812) of thesuture retriever (810) is adapted to secure a top and/or back side oftissue as the needle (802) penetrates the tissue. Further, the snare(812) of the suture retriever (810) may be configured to ensnare and/orsecure the suture. For example, the snare (812) may be tapered so thatthe suture becomes wedged in the snare (812). As another example, thesnare (812) may include a latching mechanism that allows the suture topass toward the loop in the snare (812) and remain secured until thelatching mechanism is released, either by the user or automatically(e.g., once the suture manipulation device is removed a certain distancefrom the tissue).

The needle (802) may be attached at the proximal end to a body (notshown) and/or handle (not shown) of the suture manipulation device. Inone or more embodiments of the invention, the needle (802) may beextended and retracted relative to the suture retriever (810). In otherwords, when the suture retriever (810) is held in place behind tissue,the needle (802), with suture, may be extended distally to penetrate thetissue. Further, the needle (802) may extend beyond the snare (812) ofthe suture retriever (810). Specifically, as the distal end (e.g.,(806), (808)) of the needle (802) is advanced beyond the snare (812) ofthe suture retriever (810), the distal end (e.g., (806), (808)) of theneedle (802) (including the suture) passes between the two rods andabove the semi-circular loop connecting the two rods of the snare (812)of the suture retriever (810). When the needle (802) has been extendedfar enough through the tissue, the suture may be released (as describedabove) and the needle (802) retracted back through the tissue withoutsome or all of the suture. Alternatively, the suture may be pushed wellbeyond the snare (812) but not released. The needle may then beretracted from the tissue followed by the suture retriever (810). Thesuture retriever (810), as it is retracted, may ensnare and secure thesuture, folded over the snare (812). In one or more embodiments of theinvention, the suture is ensnared by the snare (812) when the suture isreleased from the needle (802).

Continuing with FIG. 8, when the suture has been released from theneedle (802), the suture retriever (810) may retrieve the suture. In oneor more embodiments of the invention, the suture retriever (810) may notretrieve the suture until the needle (802) is withdrawn from the tissue.The suture may be retrieved using the suture retriever (810) using amanual and/or automatic process. A manual process for retrieving asuture may involve actions by a user. For example, the user may manuallyretrieve a suture by retracting the needle (802), lifting the suturemanipulation device (and thus the suture retriever (810)) upward andaway from the tissue so that the suture ensnares and secures the snare(812) of the suture retriever (810), and removing the suturemanipulation device (and thus the suture). Some or all of this processmay also be performed automatically using one or more controls.

In one or more embodiments of the invention, the needle (802) and thesuture retriever (810) (or portions thereof) of the suture manipulationdevice may rotate independently. The needle (802) and the sutureretriever (810) (or portions thereof) may also rotate in tandem.Further, the needle (802) and/or the suture retriever (810) (or portionsthereof) may be keyed, as described above, to assist with orienting theneedle (802) and/or the suture retriever (810) (or portions thereof)when protracting and/or extracting the needle (802) and/or the sutureretriever (810) (or portions thereof).

The following description (in conjunction with FIGS. 2A through 8)describes a number of examples in accordance with one or moreembodiments of the invention. The examples are for explanatory purposesonly and are not intended to limit the scope of the invention.Terminology used in FIGS. 2A through 8 may be used in the exampleswithout further reference to FIGS. 2A through 8.

EXAMPLE 1

Consider the following example, shown in FIGS. 9A through 10B, whichdescribes using a single suture manipulation device to pass suture andretrieve the suture in accordance with one or more embodiments describedabove, particularly as described above with respect to FIG. 2A and FIGS.6A through 7D. In this example, as shown in FIG. 9A, consider thescenario in which suture (902) is secured to the needle (904) of asuture manipulation device by a snare (906). Here, the needle (904) hasa penetrating point (910) at the distal end for penetrating tissue. Theproximal end of the needle (904) is connected to the body (912) of thesuture manipulation device. The snare (908) in this example is a hookand is retracted into a channel (not shown) running inside the length ofthe needle (904) through a female housing (908), located in the side ofthe needle (904) below the distal end, to secure the suture (902). Thefemale housing (908) may be configured to allow little, if any, of thesnare (906) to protrude beyond the wall of the needle (904) when thesnare (906) is fully retracted.

The snare (906) and/or the female housing (908) in the side of theneedle (904) may be configured in one of a number of ways to seat thesnare (906) flush or nearly flush with the outer side of the needle(904) when the snare (906) is fully retracted. An example of how thesnare (906) and the female housing (908) may be configured, inaccordance with one or more embodiments of the invention, is shown inFIGS. 10A and 10B. Specifically, in FIG. 10A, the snare (1014) isconfigured as a hook (1004) at the distal end and includes a key (1002)proximate to the hook (1004). The key (1002) may be a section of thesnare (1014) that is created by a bend in the snare on either side ofthe key (1002). The key (1002) may be of any length. For example, asshown in FIG. 10A, the length of the key (1002) may be approximatelyequal to the length of the opening (1016) of the channel (1008) to theside of the needle (1012). As another example, the length of the key(1002) may be less than the length of the opening (1016) of the channel(1008) to the side of the needle (1012). The key (1002) may be used tosecure the snare (1014) when the snare (1014) is in a retractedposition. The key (1002) may also be used to ensure that the snare(1014) is properly oriented (e.g., the opening of the hook (1004) at thedistal end of the snare (1014) faces the female housing (1006) of theneedle (1012)) when being retracted.

A cross section of the key is shown in FIG. 10B. Specifically, theneedle (1030) is shown to enclose the channel (1032), which in turnencloses most of the snare. The key (1034) of the snare, positioned atthe opening of the channel (1032) on the side of the needle (1030),separates the snare proximal to the key (1034) within the channel(1032), and the snare distal to the key (1034) outside of the channel(1032) and needle (1030). As the snare is retracted within the channel(1032) toward the proximal end of the needle, the key (1034) helpssecure the snare in a retracted position. As seen in FIG. 10B, a portionof the hook (1036) may protrude slightly from the outer edge of theneedle (1030). In one or more embodiments of the invention, the keyprevents rotational movement of the snare while allowing translation(e.g., protraction, retraction) of the snare.

Continuing with FIG. 10A, the needle (1012) is further configured toinclude a female housing (1006). Specifically, the female housing (1006)may be shaped to complement the hook (1004) of the snare (1014), so thatwhen the snare (1014) is full retracted, the hook (1004) sits inside thefemale housing (1006) so that little or no part of the hook (1004)protrudes beyond the perimeter of the needle (1012). In one or moreembodiments of the invention, the closer the key is located to the hook(1004), the more effective the key (1004) operates to properly orient(e.g., fit the hook (1004) into the female housing (1006)) the hook(1004) as the hook (1004) is retracted. In one or more embodiments ofthe invention, the female housing (1006) may limit the amount that thehook (1004) may be retracted so that a suture captured between the hook(1004) and the needle (1012) may slide with minimal friction.

Continuing with Example 1, FIG. 9B shows the suture manipulation deviceafter it has penetrated the tissue (920). The penetrating point (910) ofthe needle (904) is used to pierce the tissue (920) and create anopening through which the rest of the needle (904) may traverse.Further, the suture (902) remains secure as the needle (904) travelsthrough the tissue (920) because the snare (906) remains retracted.Consequently, the suture has gone through the tissue along with theneedle (904) and the snare (906).

In FIG. 9C, the snare (906) is extended from the female housing (908)and the needle (904). The snare (906) may be extended using some control(manual or automatic) for the device. Further, the snare (906) mayrotate while the snare (906) is extended and/or after the snare (906)has been extended. The snare (906) may rotate in one or more fullrevolutions or a partial revolution. The snare (906) may rotateclockwise or counterclockwise. A user may control one or more rotationalmovements of the snare (906) and/or the rotational movements may occurautomatically once the snare (906) begins to extend. As the snare (906)is extended, the suture (902) is released from the snare (906).

In FIG. 9D, the snare (906) is retracted without the suture (902). Whenthe snare (906) is retracted, the suture manipulation device is removedby being pulled back through the tissue (920). As the suturemanipulation device is removed from the tissue (920), the suture (902)remains threaded through the tissue (920).

In FIG. 9E, the suture manipulation device is positioned into adifferent location. Specifically, the needle (904) may penetrate thetissue (920) at a location adjacent to the location in the tissue (920)where the previous penetration occurred. Alternatively, the needle (904)may penetrate different tissue (not shown) that is proximate to thetissue (920). As another alternative, the needle (904) may be positionedin a location that does not penetrate any tissue (e.g., tissue (920))but that is proximately located to the suture (902) awaiting retrieval.As the needle (904) penetrates tissue (e.g., tissue (920)) or ispositioned proximate to the tissue (920), the snare (906) may remainretracted. In one or more embodiments of the invention, the needle (904)is protracted to a point such that the snare (906), when extended, mayretrieve the suture (902).

In FIG. 9F, the snare (906) is extended from the female housing (908)and the needle (904). In this case, the snare (906) is extended androtated to ensnare the suture (902). When the suture (902) is ensnaredby the snare (906), the snare (906) is retracted. When the snare (906)is retracted into the female housing (908), the suture (902) is secured.Alternatively, the snare (906) may remain extended (as shown in FIG. 9F)relative to female housing (908).

In FIG. 9G, once the suture (902) is secured, the needle (904) isremoved.

In one of more embodiments of the invention, as the needle (904) isremoved, a stitch is made with the suture (902). The entire suturemanipulation device may then be retracted, bringing the suture (902)with the suture manipulation device. When the suture manipulation deviceis removed, the snare (906) may remain extended, as shown in FIG. 9G.Alternatively, the snare (906) may be retracted when the suturemanipulation device is removed.

EXAMPLE 2

Consider the following example, shown in FIGS. 11A through 11H, whichdescribes retrieving a suture using a suture manipulation device inaccordance with one or more embodiments described above, particularly asdescribed above with respect to FIG. 2A and FIGS. 6A through 7D. In thisexample, consider the scenario in which suture (1102) is inserted intotissue (1104), as shown in FIG. 11A. The suture (1102) is retrieved tocreate a stitch. To retrieve the suture (1102), a suture retrievingdevice (1106), in accordance with one or more embodiments of theinvention, is used. As shown in FIG. 11B, the needle (1110) of thesuture retrieving device (1106) is inserted into the tissue (1104) in anarea proximate to where the stitch is desired.

Once the needle (1110) of the suture retrieving device (1106) isinserted far enough through the tissue (1104), the snare (1108) isextended from the suture retrieving device (1106), as shown in FIG. 11C.In this example, the snare (1108) protruded near the proximal end, butnot at the needle of, the suture retrieving device (1106). Further, thesnare (1108) used in this example is in the shape of a hook. A slottedopening (not shown) may be used for the snare (1108) in this example.

Once the snare (1108) is extended from the suture retrieving device(1106), the snare (1108) is rotated in order to ensnare the suture(1102), as shown in FIGS. 11D through 11F. In this example, the snare(1108) is rotated in a clockwise direction as viewed by the user. Inother words, the snare (1108) is swept in the direction of the openingof the hook so that the hook may ensnare the suture (1102).

When the rotation of the snare (1108) captures the suture (1102), thesnare (1108) is retracted into the suture retrieving device (1106), asshown in FIG. 11G. As the snare (1108) retracts, it brings the suture(1102) toward the suture retrieving device (1106). When the snare (1108)is completely retracted, the suture (1102) is secured against the sutureretrieving device (1106).

As shown in FIG. 11H, the suture retrieving device (1106), along withthe suture (1102), is then retracted through the tissue (1104). Once thesuture retrieving device (1106) is fully removed from the tissue (1104),the stitch may be completed.

EXAMPLE 3

Consider the following example, shown in FIGS. 12A through 12D, whichdescribes retrieving a suture using a suture manipulation device inaccordance with one or more embodiments described above, particularly asdescribed above with respect to FIGS. 2B and 8. Consider the scenario inwhich a stitch is made using suture (1212) passed through tissue (1206)that requires support to be held in place. Initially, in FIG. 12A, thetissue (1206) is secured using a snare (1210) located at the distal endof a suture retriever (1208). Specifically, the distal end is placedbehind the tissue (1206) that is being penetrated. For purposes of thisexample, the components of the suture manipulation device are configuredas described above with respect to FIG. 8.

Once the tissue (1206) is secured using the snare (1210) of the sutureretriever (1208), the needle (1204) is used to pass the suture (1212)through the tissue (1206), as shown in FIG. 12B. In this example, theneedle (1204) is advanced through the tissue (1206) while the sutureretriever (1208) and the body (1202) remain in a substantially fixedposition relative to the tissue (1206). The tissue (1206) is held inplace by the snare (1210) of the suture retriever (1208) as the needle(1204), along with the suture (1212), penetrates and passes through thetissue (1206). In this example, the distal end of the needle (1204) isadvanced beyond the snare (1210) of the suture retriever (1208).Further, as the distal end of the needle (1204) is advanced beyond thesnare (1210) of the suture retriever (1208), the distal end of theneedle (including the suture (1212)) passes between the two rods andabove the semi-circular loop connecting the two rods of the snare (1210)of the suture retriever (1208). When the needle (1204) (as well as thesuture (1212) manipulated by the needle (1204)) is passed far enoughbeyond the tissue (1206), the suture (1212) is released from the needle(1204).

After the suture (1212) is released from the needle (1204), the needle(1204) is retracted through the tissue (1206), as shown in FIG. 12C.Similar to protracting the needle (1204), as described above withrespect to FIG. 12B, the body (1202) and the suture retriever (1208) mayremain in a substantially fixed position relative to the tissue (1206)as the needle (1204) is retracted out of the tissue (1206) and into thebody (1202).

Once the needle (1204) is retracted enough (e.g., fully retracted intothe body (1202), completely clear of the tissue (1206)), the sutureretriever (1208), using the snare (1210), ensnares and secures thesuture (1212), as shown in FIG. 12D. The suture (1212) may be ensnaredin the snare (1210) in one of a number of ways. In this example, thesnare (1210) is lifted to clear the tissue (1206), which also ensnaresthe suture (1212) between the two rods and the semi-circular loop thatconnects the two rods in the snare (1210). The snare (1210) may belifted by lifting and/or tilting the body (1202). When the suture (1212)is secured in the snare (1210), then the entire device is removed.

One or more embodiments of the invention provide for manipulating asuture. Specifically, embodiments of the invention allow a user to moreefficiently push and/or retrieve a suture to create one or more stitchesin tissue. Creating accurate stitches in tissue may be a time-consumingprocess because of the size of the instruments (e.g., suture, needle,suture retrieving device) used and/or because of the small space inwhich to work to create stitches in the tissue. Embodiments of theinvention may reduce the amount of time spent by the user and increasethe accuracy of the stitches created by the user.

In embodiments of the invention, the user may be a surgeon, nurse,technician, doctor, veterinarian, or other similar professional creatingstitches in tissue to close a wound. Embodiments of the invention mayallow a user to secure tissue from migrating or moving away when thetissue is pierced to pass a suture. Embodiments of the invention mayalso eliminate the need to use a separate instrument to retrieve thesuture after the suture has passed through the tissue. Embodiments ofthe invention may also eliminate the need to use a separate backingdevice (e.g., bone) to provide stability to soft tissue as the tissue ifpierced. Embodiments of the invention may also automatically capture thesuture as the suture is passed through the tissue.

Further, embodiments of the invention may allow a suture to be passedthrough tissue with a suture manipulation device having a minimaldiameter (1.0 mm or less). Currently, instruments of approximately 2.5mm in diameter are used to manipulate suture through tissue. Embodimentsof the invention also provide the advantage of incorporating a suturepusher and a suture retriever into a single instrument or device.Embodiments of the invention also provide the advantage of a retractablesnare that is adapted to ensnare and secure the suture for retrieval.Rotating the snare in one or more rotational directions allowsembodiments of the invention to more easily and efficiently ensnare andsecure the suture for retrieval.

While the invention has been described with respect to a limited numberof embodiments, those skilled in the art, having benefit of thisdisclosure, will appreciate that other embodiments can be devised whichdo not depart from the scope of the invention as disclosed herein.Accordingly, the scope of the invention should be limited only by theattached claims.

1. A suture manipulation device comprising: a body; and a snare operatively connected to the body and adapted to: protract from the body; rotate, after protracting from the body, independent of the body; ensnare a portion of suture passed through tissue while rotating; and secure the portion of the suture.
 2. The suture manipulation device of claim 1, wherein the body has a length and comprises: a shaft located inside the body and running proximally along the length of the body; and a needle at a distal end of the body adapted to: secure the portion of the suture; pierce the tissue; and release, after piercing the tissue, the portion of the suture.
 3. The suture manipulation device of claim 2, wherein the needle is curved.
 4. The suture manipulation device of claim 2, wherein the needle releases the portion of the suture before the portion of the suture is ensnared by the snare.
 5. The suture manipulation device of claim 1, further comprising: a pushrod having a distal end and a proximal end, wherein the pushrod is adapted to independently slide and rotate within the shaft of the body, and wherein the distal end of the pushrod is operatively connected to the snare.
 6. The suture manipulation device of claim 5, wherein the pushrod is retracted proximally to secure the portion of the suture by the snare.
 7. The suture manipulation device of claim 6, further comprising a sensor adapted to: measure, while retracting the pushrod proximally, a tension in the snare; determine that the tension exceeds a tension threshold; and notify a user that the portion of the suture is secure.
 8. The suture manipulation device of claim 5, wherein the pushrod slides within the shaft using a control at a proximal end of the body.
 9. The suture manipulation device of claim 5, wherein the control comprises an actuation button located at a proximal end of the body and adapted to: extend the snare from the body; rotate the snare to ensnare the portion of the suture; and retract the snare.
 10. The suture manipulation device of claim 2, wherein the needle comprises an angled slot forming a cavity large enough to allow the portion of the suture to pass.
 11. The suture manipulation device of claim 10, wherein the pushrod, when fully pushed toward the distal end using the control, presses against the portion of the suture in the angled slot of the needle to hold the portion of the suture in place while the needle penetrates the tissue.
 12. The suture manipulation device of claim 10, wherein the pushrod, when retracted toward the proximal end using the control, holds the portion of the suture in place using the snare while the needle penetrates the tissue.
 13. The suture manipulation device of claim 1, wherein the snare comprises a flexible material that forms a closed loop.
 14. The suture manipulation device of claim 1, wherein the snare comprises a wire having a thickness and distally shaped as a hook, wherein the wire comprises a diameter and a bend proximal to the hook.
 15. The suture manipulation device of claim 14, further comprising: a slot located distally in the body and adapted to receive the hook when the hook has a particular orientation relative to the slot, wherein the hook is substantially retracted into the slot when securing the portion of the suture.
 16. The suture manipulation device of claim 15, wherein the slot is located at a distal end of the needle.
 17. The suture manipulation device of claim 15, wherein the slot is located along the length of the body.
 18. A suture manipulation device comprising: a snare comprising a receiving end adapted to: provide support to tissue; ensnare a portion of suture passed through the tissue and the receiving end; remove the support of the tissue; secure, while removing the support of the tissue, the portion of the suture using the receiving end; and remove, using the receiving end, the portion of the suture.
 19. The suture manipulation device of claim 18, further comprising: a needle operatively connected to the snare and adapted to: secure the portion of the suture; pierce, while the tissue is supported by the receiving end of the snare, the tissue; pass the portion of the suture through the tissue and the receiving end of the snare; release the portion of the suture; and retract through the tissue.
 20. The suture manipulation device of claim 18, wherein the needle moves independently of the snare.
 21. The suture manipulation device of claim 18, wherein the snare comprises two parallel rods connected by a semi-circular loop and is bent to at least a 90° angle relative to a body of the suture manipulation device, wherein the body is operatively connected to the snare.
 22. The suture manipulation device of claim 21, wherein the needle is further adapted to pass proximately between the semi-circular loop and the two parallel rods of the snare.
 23. A method for manipulating a suture, the method comprising: protracting a snare from a body of a suture manipulation device; rotating the snare independent of the body of the suture manipulation device; ensnaring a portion of the suture with the snare while rotating the snare; and securing the portion of the suture.
 24. The method of claim 23, further comprising: passing the portion of the suture through tissue using a needle, wherein the needle: punctures the tissue while securing the portion of the suture; holds the portion of the suture in place while puncturing the tissue; and releases the portion of the suture after puncturing the tissue.
 25. The method of claim 24, wherein the needle is integrated with the suture manipulation device.
 26. The method of claim 25, further comprising: a pushrod adapted to control the snare and have a plurality of positions within a cavity of the suture manipulation device, wherein the plurality of positions is controlled proximally using a control.
 27. The method of claim 26, wherein the control is an actuation button.
 28. The method of claim 26, wherein the pushrod, when positioned distally using the control, presses against the portion of the suture in an angled slot of the needle to hold the portion of the suture in place while the needle penetrates the tissue.
 29. The method of claim 26, wherein the pushrod, when retracted proximally using the control, holds the portion of the suture in place using the snare while the needle penetrates the tissue.
 30. The method of claim 26, further comprising: rotating the pushrod in the cavity of the suture manipulation device to rotate the snare operatively connected to a distal end of the pushrod.
 31. The method of claim 30, wherein the portion of the suture is secured with the snare by retracting the pushrod proximally.
 32. The method of claim 26, wherein securing the portion of the suture comprises: measuring, while retracting the pushrod proximally, a tension in the snare; determining that the tension exceeds a tension threshold; and notifying a user that the portion of the suture is secure.
 33. The method of claim 23, further comprising: retracting the suture manipulation device with the portion of the suture from the tissue.
 34. The method of claim 23, wherein the snare comprises a flexible material that forms a closed loop.
 35. The method of claim 23, wherein the snare comprises a wire having a thickness and shaped as a hook, wherein the hook comprises a diameter at a distal end of the wire and a bend proximal to the hook.
 36. The method of claim 35, wherein the snare is retracted in a slot in the suture manipulation device, wherein the slot is adapted to receive the snare when the snare has a particular orientation relative to the slot.
 37. The method of claim 36, wherein the slot is located at a distal end of the needle.
 38. The method of claim 36, wherein the slot is located along a length of the suture manipulation device.
 39. The method of claim 23, wherein the needle is a hypodermic needle.
 40. The method of claim 39, wherein the hypodermic needle is curved.
 41. The method of claim 23, wherein the portion of the suture is released from the needle before being ensnared by the snare.
 42. A method for manipulating a suture, the method comprising: providing support to tissue using a snare of a suture manipulation device; ensnaring, using the snare and without moving the snare, a portion of the suture when the portion of the suture passes through the tissue and is released by a needle; securing, while removing the support to the tissue, the portion of the suture with the snare; and removing the snare with the portion of the suture from the tissue.
 43. The method of claim 42, wherein the snare and the needle are part of a device.
 44. The method of claim 42, wherein the snare comprises two parallel rods connected by a semi-circular loop and is bent to an angle that is approximately perpendicular to the needle passing through the tissue.
 45. The method of claim 44, wherein the portion of the suture passes proximately between the semi-circular loop and the two parallel rods of the snare. 